AI platforms have been serving as virtual therapists and health advisors for the last few years. And given the shortage of mental health care providers and primary care providers, there has undoubtely been some benefit, for many, to these faceless stand-ins. News of the release of a health and wellness version of ChatGPT was the talk of the medical community last week. The platform’s landing page states that this more secure version of the original is not intended to replace medical care and should not be used to diagnose or treat medical conditions. In a medical system driven by insurance and insurance company profits, online inquiries, posed by those who are confused and overwhelmed by their health, will no doubt sometimes be interpreted as diagnosis and a plan for treatment. And yet, I am confident it will never take the place of a competent naturopathic clinician.
Naturopathic medicine is a very small subset of our healthcare system. There are approximately 5,000 practicing NDs in the United States.* The practice of naturopathy is not mainstream and the education is not either. Naturopathic medical schools do cover the same course work that conventional medical programs do – anatomy and physiology, biochemistry, pathology, pharmacology, and diagnostic methods – but they also teach botanical medicine, nutrition, homeopathy, osseus manipulations, and mind-body medicine. While components of these complementary methods are available to the general public on websites and blogs, and will be therefore be included in the information shared by AI platforms, these knowledge systems have primary been passed down, from teacher to learner, offline. Some botanical medicine and nutritional interventions have been well researched and are published in peer reviewed journals and others, such has homeopathy, exist in paradigms that do not stand up well to the reductionist research methods that are the focus of our current scientific studies. When I look at my notes, from my four years at Bastyr University, I know that the sum total of clinical pearls and plant knowledge and advice from elders, that was shared with me by clinical herbalists, small town medical doctors, chiropractors, psychologist, and naturopathic doctors from various eras is not available to ChatGPT. Nor is the ability to synthesize this information for a treatment plan unique to the person sitting in my office. This subset of medicine is small but it’s a unique amalgam of ancient medical knowledge, energy healing insights, understanding of various ecosystems, and also published research.
But beyond the advice or insights that will be missing from the results generated by artificial intelligence, is the relational component of good medicine. Human beings are relational and healing is dependent on one’s community; it does not happen in isolation. The holistic perspective of naturopathic medicine is acutely aware of this; healing depends on a positive doctor-patient relationship, a sense of meaning in one’s life and a degree of love or belonging in one’s community. Improving one’s health is more than taking medicine or certain supplements that address deficiencies, it often also involves some sort of behavior change. Exercising more, creating a mindfulness practice, or prioritizing sleep are behavior changes that we’ve likely all considered at one point in time. And this time of year, conversation about New Year’s resolutions are common. But what’s the difference between those commitments that remain thoughts and those that actually shift the needle on our health or biomarkers? Often it’s our relationships or our community. It’s the presence of those who help motivate us, hold us accountable, and make behavior change easier through companionship or sharing information or expertise.
Chat GPT Health may tell you what supplements might be helpful to include in your regimen but that is not what naturopathic medicine is. Naturopathic medicine involves looking at a person’s full life – from birth to the present moment – and identifying factors that might have influenced their present state of health. It is looking at this full picture and aligning it with one’s personal goals and identifying barriers to behavior change. And then it’s the naturopathic doctor’s job to support the person, through a trusting and transparent doctor-patient relationship, to create a plan that will help them to feel better and meet their health goals and to talk about what their individual timeline for this work might look like. While there are pieces of this work that might show up on the Chat GPT Health screen, this holistic and relational approach cannot be replaced by an artificial being.
It has been postulated that doctor-patient relationships have deteriorated in recent years due, possibly, to the rise in medical technology, focus on profits in healthcare, and dictates of insurance driven medicine (Jensen, 1981). I suspect that this deterioration contributes to the feeling that AI may be the solution for the gaps in our current healthcare system and the relationships with our providers. But just like ChatGPT can’t serve as a couples therapist for a failing romantic relationship, it also shouldn’t keep you from finding a care team that you feel can meet your needs. Or discussing these needs with your current providers. And, for those who have not worked with a naturopathic doctor before, introducing this doctor-patient relationship to your care team may be surprising beneficial. Because these providers often work outside of the insurance and corporation based medical model, these appointments can serve as reminders of how medicine used to be. Naturopathic doctors focus on getting to know their patients, establishing a trusting relationship, and helping to provide health education that is individualized for the person in their office rather than the doctor-google or crowd sourcing approach many have reverted to.
I don’t doube that artificial intelligence will significantly change healthcare and will have many benefits which I have yet to imagine. And, I imagine that many will use ChatGPT Health to serve as a functional medicine provider that can spit out solutions to abnormal lab results. But it will never replace the role of a skilled naturopathic doctor. I suspect those who disagree, probably don’t have a relationship with an intelligent and compassionate ND.
* For comparison, the annual conference for the American Academy of Family Physicians, representing only one medical specialty, tends to have that many attendees each year.
References
Jensen, P. S. (1981). The doctor-patient relationship: Headed for impasse or improvement? Annals of Internal Medicine. 95(6). doi: 10.7326/0003-4819-95-6-769.